Dr. Joe Galati's Blog

New Hepatitis C Therapies Are Closer Than Ever

Telaprevir, Boceprevir Improve HCV Cure Rates. The new therapies for chronic hepatitis C are closer than ever. While we have been participating in conducting may of these trials, it has never been more exciting for both patients and physicians who care for hepatitis C patients. Here is an anaylsis from the recent AASLD meeting in Boston this month. Read more here.

Dr. Joe Galati and Lauren Thomas, R.N., NP-C, Discuss Hepatitis C Treatment

In this post, Lauren Thomas, our nurse practitioner in our office, discussed with me various aspects of anti-viral therapy for chronic hepatitis C. Lauren provides a common-sense approach to dealing with the side effects, and how we successfully manage them, allowing for better tolerance,and success with the therapy.

Listen to the audio podcast below.

 

 

Download Listen to HCV Therapy

 

 

Wall Street Journal Article on Hepatitis C

Melinda Beck from the Wall Street Journal wrote an excellent article on Hepatitis C that was published today. It features a number of our patients, and their experience with the new research studies we are performing. The article can be read here.

For additional information on becoming a candidate for these new research studies, contact us at 713- 634-5110. Visit our research staff page for more information.

Boceprevir Improved Hepatitis C Response in Genotype 1 Patients-Dr. Paul Kwo Interview

Dr. Paul Kwo was on Your Health First with Dr. Joe Galati this past Sunday evening, discussing the latest results published this past week in the medical journal Lancet, which discussed the new finding with the drug Boceprevir. The response rates in chronic hepatitis C, genotype 1, are significantly improved compared to standard of care therapy currently available.

Listen to the interview here.

Paul Kwo HCV Interview

 

Vertex Pharmaceuticals: Teleprevir Results Promising for Chronic Hepatitis C

Vertex Pharmaceuticals Inc. (VRTX) reported strong results from the first of three key late-stage studies of hepatitis-C treatment, telaprevir, showing success in three-quarters of patients using the drug for 12 weeks.

This is very good news for both patients and physicians involved with chronic hepatitis C. Hepatitis C infects well over 4 million Americans. Complications of hepatitis C include cirrhosis, hepatocellular carcinoma (liver cancer), and the potential need for a liver transplant. Currently available FDA approved therapies can attain a 45-55% sustained viral response to 48 weeks of combination therapy with Interferon and Ribavirin in genotype 1 individuals.

Research continues with many new agents targeting the hepatitis C virus. With FDA approval in the near future, the tools we will have to treat our patients will vastly change the practice of medicine for those with hepatitis C, achievingsignificantly greater viral clearance. Good time lie ahead.

Everything You Wanted To Know About Liver Biopsy

 

Our practice, Liver Specialists of Texas, recently produced a video outlining what is involved with a liver biopsy.

Send us your comments.

 

 

Treating Hepatitis B and C with Human Liver in Mice

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infect liver cells, and persistent infection can lead to cirrhosis of the liver and/or a form of liver cancer known as hepatocellular carcinoma. Over 4 million Americans have hepatitis C, many more are infected and do not know they have it. Current research using small animal models of HBV and HCV infection are not particularly good, and new models are needed if we are to learn more about how these viruses operate and test new potential therapeutics. Researchers at the Salk Institute for Biological Studies, La Jolla, have now developed a human liver chimeric mouse model by transplanting a large number of human liver cells into mice lacking three proteins (Fah, Rag2, and Il-2r-gamma) to generate mice with livers in which 95% of the liver cells are human. Of interest, these mice could be infected with HBV and HCV, and mice infected with HCV were responsive to antiviral therapy. This mouse model should prove useful not only for studying HBV and HCV infection and testing antiviral therapies but also for studying other infections microorganisms that target the liver.

If in fact an animal model works as describes here, the expanded use of animals in the research and development of new antiviral therapies will be a huge step forward in developing better therapies. While we have made great advances with the lates new agents for both HBV and HCV, the therapies, especially for hepatitis C, do have side effects.

Download the article HCV Mice and theEditorial Mice  here.

What do you think?

 

 

The Skinny on Chronic Hepatitis C

No doubt, obesity is a massive public health issue here in America, as welll as rest of the developed world. We think about diabetes, heart disease, and chronic lung disease when we talk about the obesity related health complications. Now we can add chronic hepatitis C, and the increased rate of progression related to obesity. There have been numerous recent articles published regarding these two diseases.

James E. Everhart and colleagues published an excellent article in the journal, Gastroenterology, looking at the weight-related effects on disease progression in hepatitis C. They found the following:

This study showed an association of several weight-related features to increased rates of liver disease progression among patients with advanced chronic hepatitis C. In particular, insulin resistance and histologic features of fatty liver disease at baseline were strongly associated with progressive liver disease. Of greatest clinical significance, weight change during the trial was associated with liver disease outcomes. Although this study was performed among a selected group of patients with treatment-resistant hepatitis C, it is likely that the findings would extend to other patients with hepatitis C. In addition, the relations of weight-related features and outcomes were consistent for the 2 randomized groups, with the exception of HOMA2-IR, which was strongly associated with disease progression among untreated patients but not among patients assigned to treatment.

Hepatitis C Research Opportunities: Research Specialists of Texas

In 2010, our practice will continue to conduct investigational studies in hepatitis C, making of use of new, very effective drugs to combat chronic hepatitis C. For most of the studies, they will include genotype 1 patients, who have never received any form of antiviral therapy against their hepatitis C. These naive patients will receive a three or four drug combination, with expected response rates of over 90%.  Additionally, studies with patients previously treated will also become availabe later in 2010.

If interested, contact Herman Ortiz, Research Specialists of Texas, at 713-794-0700.

Hepatitis C Update: A Video Blog Entry

The AASLD has released "Diagnosis, Management, and Treatment of Hepatitis C: An Update, in the April 2009 edition of the journal Heptology. It can be downloaded here:  Download HCV Updates

I have for you a brief video of some of the highlights of the article, though due to the exhaustive nature of the article, it is best to download and read yourself when you have an hour. It covers just about every aspect of hepatitis C, and will serve as the foundation for management in the years to come.

Click here for video blog: Download AASLD Update 2009

Hepatitis C and India

A recent report states that every 15th carrier of the Hepatitis C virus (HCV) is an Indian and 12.5 million Indians suffer from HCV, with the death rate exceeding over 100,000 per year, a doctor's conference here was told. This clearly is a large public health concern, considering the number of immigrants from India moving to the Unites States.

New Hepatitis C Drug Disappointing

For those of us on the front line treating heaptitis C, the hope of new therapies that will provide our patients a better response rate is our dream. With the current FDA approved therapies, we are seeing a 45-55% response rate, with some slight variation based on race, genotype of the virus, and liver damage noted on liver biopsy.

Protesase inhibitors, a new class of antivirals for hepatitis C, are currently being investigated (including at our site), and the initial results are very impressive.

Unfortunately, and new compound, manufactured by Human Genome Sciences, Albuferon, was no better in response rate when compared to standard FDA approved therapies we already have.

Human Genome Sciences' (HGSI.O) drug to treat chronic hepatitis C met the main goal in a late-stage trial, but failed to show numerically better efficacy compared to standard-of-care, raising questions about the drug's adoption and sending shares crashing to an all-time low.

Analysts had expected the trial to meet its main goal of non-inferiority compared to Pegasys, but they had also said that the trial must show numerically better sustained virologic response (SVR) rates to convince the market of the drug's commercial viability.

In the trial, named ACHIEVE 1, patients were either given the drug Albuferon every two weeks or standard-of-care Pegasys once weekly and the company said the rate of SVR among the two groups "was comparable."

"This means that you have a drug that is statistically comparable but for the vast majority of prescribers who have used Pegasys for ever, they are not going to change their prescribing trends based on this data," said Piper Jaffray analyst Edward Tenthoff.

The current standard of care for hepatitis C is antiviral ribavirin in combination with an interferon. Human Genome's Albuferon, which is a type of interferon, was also being studied in combination with ribavirin. Read more

For now, it's back to the drawing board. There are indeed new therapies that will improve upon the current drugs we have available. Stay tuned...help is on the way.

Hepatitis C and Coffee? Make it a Latte.

Over the years, a lot has been written about the potential health benefits of drinking coffee. Recently, there was a study published showing that women who consume two to three cups of coffee a day have a significant drop in the incidence of stroke.

 

At last year’s annual meeting for the American Association for the Study of Liver Diseases, a paper was presented showing that coffee intake is linked to lower risk of hepatitis C related liver disease progression. Moderate coffee consumption may help slow the progression of liver disease related to hepatitis C according to an observational study.

Among patients with established liver disease who drank at least three cups of coffee daily, had a 50% lower progression over three and a half years according to Dr. Neal Freedman, Ph.D., from the National Cancer Institute. His research is consistent with prior studies showing that coffee intake decreased the liver enzymes with an associated risk of cirrhosis and progression of liver disease. There is also some suggestion that hepatocellular carcinoma is also reduced. The exact reason why coffeeintake is associated with less progression of liver disease is unclear. Is it the actual coffee or some habit that coffee drinkers participate in that actually causes the decreased risk of liver progression. 

In reviewing the cases, the investigators found that coffee intake was associated with a decrease in ascites, death, hepatic encephalopathy, spontaneous bacterial peritonitis, variceal bleeding, and a decrease in the progression of the fibrosis noted on baseline liver biopsy. It is interesting to note that drinking tea had no influence on liver progression.

What is a patient to do? Well, it appears if you have chronic liver disease coffee may be helpful but certainly there does not appear to be any downside to consuming coffee. It iswell known that coffee is an antioxidant, and this may be the ultimate beneficial effect. 

For many Americans, coffee intake is the number one source of antioxidants in their diet. Until further research is conducted, I would say it would be fine to continue to have your morning cup or two of coffee. In addition to coffee, it is clear that a diet free of alcohol certainly is protective as well.

A Misunderstood Point About Chronic Hepatitis C

Hepatitis C is a chronic infection. Once exposed through the usual risk factors, there is a better than 85% chance the virus will stick with you, avoiding clearance by the immune system. That's it.

As a reminder, the Centers for Disease Control list the risk factors for hepatitis C:

Who is at risk for hepatitis C?

Some people are at increased risk for hepatitis C, including

• Current injection drug users (currently the most common way hepatitis C virus is spread in the United States)
• Past injection drug users, including those who injected only one time or many years ago
• Recipients of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992)
• People who received a blood product for clotting problems made before 1987
• Hemodialysis patients or persons who spent many years on dialysis for kidney failure
• People who received body piercing or tattoos done with non-sterile instruments
• People with known exposures to the hepatitis C virus, such as
  • Healthcare workers injured by needlesticks
  • Recipients of blood or organs from a donor who tested positive for the hepatitis C virus
• HIV-infected persons
• Children born to mothers infected with the hepatitis C virus

Less common risks include:

• Having sexual contact with a person who is infected with the hepatitis C virus
• Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person

The misunderstood part is that there is the belief that those newly diagnosed with chronic hepatitis C have been infected recently, but in reality, the vast majority of the patients were exposed the better part of 20 years. Experimentation with IV drugs and blood transfusions are the two major risk factors I see on a daily basis. For all of these years, they have had hepatitis C. The test for hepatitis C is not always part of routine screening. In other words, if it is not specifically requested, it will not be done by your family physician during your annual exam. If you don't look, you won't see it. That simple.

It's incredibally difficult for patients to comprehend how they "could have this for all these years" and not know about it. For many, they are free of symptoms and enjoying life.

Take home message: most patients with HCV have had it for many years. If you have any of the risk factors you must ask to be tested. Amen.

Singer Natalie Cole Being Treated for Chronic Hepatitis C

Another well know celebrity has come public on their diagnosis of hepatitis C. In recent news articles, it states that Natalie Cole, daughter of Nat King Cole, has previously been diagnosed with and currently receiving therapy with interferon and ribavirin. The article state that she is responding to the therapy, but due to the expected side effects of the medication, has come off the road from touring for the time being.

Her reported risk factor for contracting hepatitis C (HCV) is a past history of drug abuse. Both intranasal and intravenous drug use is associated with transmitting the HCV virus from one person to another. Here is a list of risk factors for HCV that everyone should be aware of. The common conversation I have every day is regarding HCV risk factors. Today, the majority of patients have either blood transfusions of intravenous drug use as their unique risk factor. Even if you experimented 30 years ago, one time, that is a risk factor and you need to be tested.

As a society, we need to get past the stigma associated with both liver disease and hepatitis C. These established stigma get in the way of people getting in for timely treatment.

Acute Hepatitis C Review

In the January 2008 issue of the journal Hepatology, Dr. Jason T. Blackard and colleagues have written an excellent review of acute hepatitis C. The article covers all aspects of this very important infection, including its history and discovery, epidemiology and natural history, transmission, role of the immune response, and therapy.

Acute hepatitis is a rare presentation, and few have seen it clinically. The vast majority of patients diagnosed with hepatitis C are diagnosed years or decades later.

This review serves as an excellent review of the topic, putting the acute infection back into our consciousness once again.